Nursing Professional Development Leadership

Issues of Concern

Several factors influence the role of the NPD leader, including leadership characteristics and skills, leadership styles—such as transformational leadership—and legal and ethical responsibilities. Additional considerations include demonstrating the value of NPD practice, navigating complex healthcare systems, and applying scientific rigor to advance the specialty.

Leaders often share a core set of characteristics. Hughes reviewed 10 national and international research studies conducted between 2002 and 2015 to identify the traits of exceptional nurse leaders.[3] The leadership characteristics highlighted in the review included integrity, accessibility, the ability to motivate others, emotional intelligence, and social intelligence. Effective leaders are open and approachable, and they inspire others through support, encouragement, and empowerment.

Other qualities that nurses value in their leaders include a commitment to excellence, passion for their work, a clear vision and strategic focus, trustworthiness, respect, approachability, empathy, caring, and a dedication to coaching and developing staff. These attributes are essential for exceptional leadership. Organizations must focus on the best methods to identify and develop these traits in both existing and emerging leaders.

Skills required to develop these leadership characteristics include effective communication, fostering a healthy work environment, collaboration, shared decision-making, coaching and mentoring, and appropriate delegation. Strong verbal and written communication skills are essential for effective leadership. Leaders must create and maintain a healthy work environment that supports the physical, social, and mental well-being of both patients and staff. This involves actively giving and soliciting feedback. Exceptional leaders listen attentively, speak thoughtfully, and respond with care and intention cautiously.

In today’s dynamic healthcare environment, with its emphasis on interprofessional education, leaders must develop strong working relationships with members of all disciplines within the healthcare team. Effective leaders promote shared decision-making, ensuring that stakeholders are actively engaged and supported through continuous coaching, mentoring, and ongoing support for staff members. Beyond serving as role models, leaders empower team members by providing the tools and resources needed to succeed, then stepping back to allow them to perform independently. They also recognize opportunities to motivate others by acknowledging their value, contributions, and service. Strong delegation skills are essential, as no leader can achieve strategic goals in isolation.

Many leadership texts highlight similar core leadership activities, including, but not limited to, strategic planning, managing human and fiscal resources, environmental scanning, delegation, quality improvement (QI), program and project management, and fostering innovation. Additionally, the authors stress the importance of adopting a transformational leadership style.[4] 

Schmidt developed a transformational leadership model based on data gathered through standardized interviews with 15 leaders from both healthcare and non-healthcare organizations. Schmidt emphasized that transformational leadership can only thrive in an environment of integrity, respect, and authenticity. The 5 key attributes of transformational leadership include being visionary, taking risks, being an effective communicator, motivating others, and demonstrating persistence. These attributes align closely with the 4 components of transformational leadership, which include idealized influence, inspirational motivation, intellectual stimulation, and individualized consideration.[5]

Transformational leadership is a style that inspires positive change in followers. Transformational leaders are energetic, enthusiastic, and passionate, motivating others to shift their expectations, perceptions, and motivations to achieve shared goals. They act as role models, challenge the status quo, foster creativity, maintain a clear vision, and provide continuous support and encouragement.

Leaders must have a deep understanding of the organizational culture in which they operate. Recognizing how the organization thinks is crucial for aligning with its goals and for helping individuals navigate the changes that occur within any organization. Departmental goals should be aligned with organizational objectives, and leaders must be able to clearly articulate their department's value to senior leadership.

All leaders must adhere to legal and ethical guidelines in carrying out their responsibilities. In the increasingly complex healthcare environment, leaders frequently encounter a range of ethical and legal challenges. Legal requirements are defined by local, state, or national laws, and regulatory bodies impose additional standards. Leaders must ensure compliance with these regulations, including health reporting requirements and privacy protections such as those outlined in the Health Insurance Portability and Accountability Act (HIPAA). Ethical standards guide expected behaviors within the practice setting. The NPD standards include a dedicated standard on ethics: "The nursing professional development practitioner integrates ethics into all aspects of practice” (p. 86). Specific ethical competencies are outlined for both NPD practitioners and NPD specialists.

Special legal and ethical issues affecting the NPD practitioner may include concerns related to copyright, content integrity, intellectual property, maintaining a just culture, protecting learners’ rights and dignity, and ensuring appropriate documentation.[6] Ethics in NPD practice emphasizes the integration and application of organizational policies alongside the standards established by national professional organizations.

In 2021, Harper et al replicated a study examining the correlations between NPD staff and organizational outcomes.[7][8] Both leaders and NPD practitioners frequently inquire about the average number of individual employees and registered nurses (RNs) under the supervision of an NPD practitioner, as well as the average number of NPD practitioners per hospital bed capacity. A descriptive, cross-sectional design was employed in the study, which included a survey comprising 89 items (93 items were from the National Database for Nursing Quality Indicators [NDNQI] participating organizations). The study collected 398 usable surveys from organizations across 46 states and the District of Columbia.

The first report from this study presented background information and descriptive data on organizational characteristics, NPD department structure, and NPD practitioner ratios per employee, RN, and hospital bed. The second part of the study explored the relationships between NPD staffing and organizational outcomes. Findings indicated that higher levels of NPD staffing were associated with improved nursing and patient outcomes.

NPD leaders must demonstrate the value of NPD practice. Church et al conducted a review of 13 transition-to-practice (TTP) programs accredited by the American Nurses Credentialing Center (ANCC) Practice Transition Accreditation Program (PTAP).[9] In 2014, the ANCC launched the PTAP to recognize residency and fellowship programs. These programs are evaluated against 38 evidence-based standards, including program leadership, organizational enculturation, curriculum development and design, practice-based learning, NPD, and quality outcomes. Qualitative data were collected from the annual reports of 13 accredited programs.

Notably, 6 overarching themes were identified—leadership support, stakeholder interest, national and state recognition, credibility, collaboration with other facilities, and funding. As leaders of TTP programs, NPD practitioners can provide value to organizations by enhancing the quality of nurse development during transitions and contributing to improved patient and family care outcomes.

Although many organizations offer leadership programs to support nurses transitioning into formal leadership roles, fewer focus on developing informal leaders, such as direct care clinical nurses (CNs). Morse and colleagues described a “Rising Star” program created specifically as a CN leadership program.[10] Initially designed to equip high-performing direct care CNs with the skills and knowledge needed to thrive as informal leaders, the program later evolved to further enhance the expertise of experienced nurses. The goal was to empower them to foster exceptional patient outcomes and experiences while serving as role models for their peers.

This 12-month program includes 8 hours of monthly classroom and virtual content, with a focus on developing a QI project. All QI projects were completed, and 19 have been successfully integrated at the unit, department, or institutional level. In total, 41% of participants worked on an abstract, with 8 submissions made to conferences. Additionally, 59% of participants have pursued advanced formal education. The program has received highly positive feedback. The Rising Star facilitator, an NPD specialist, exemplifies leadership by managing the application process, chairing the selection committee, overseeing applicant notifications, reporting program outcomes to executive leadership, and facilitating both the program and the classes.

With the growing number of mergers, NPD leaders are increasingly part of multisite systems. Boerger shared her insights on the challenges of leading such systems.[11] To address these challenges, Harper et al conducted a study to reach consensus on the competencies required for individuals leading multisite systems.[12] 

The quantitative study used a modified electronic Delphi (eDelphi) method to determine the competencies required by leaders of multisite systems. In total, 24 participants completed at least 50% of the initial survey, 21 completed round 2, and 17 completed the third and final round. The study identified 5 key competency domains necessary for multisite NPD leaders—executive nursing leadership, NPD practice, business acumen, organizational alignment, and communication and relationship building. A complete list of multisite competencies in these areas is available on the ANPD website.

Clinical Significance

NPD leaders play a vital role in advancing the specialty within professional practice settings and the broader nursing profession. They support the professional growth of nurses and other healthcare personnel across diverse environments, while promoting interprofessional education and collaboration. As champions of scientific inquiry, NPD leaders also contribute to the advancement of the specialty through mentoring and fostering the professional development of others.

Nursing, Allied Health, and Interprofessional Team Interventions

In today’s evolving healthcare landscape, nursing leaders must collaborate closely with members of the interprofessional team to ensure the delivery of high-quality patient care. This includes fostering healthy interprofessional and learning environments that support teamwork and professional growth. Strong interprofessional partnerships are essential for achieving safe, effective, and high-quality outcomes. Collaboration across all healthcare disciplines is a key driver of patient safety and optimal care delivery.